Budget impact analysis : an illustrative case of glucosamine in knee osteoarthritis

Abstract

Competition among new pharmaceutical products for formulary inclusion continues to dominate the concern of healthcare decision makers. Affordability became an importance issue in line with cost-effectiveness. The budget impact model provides a comprehensive result to aid the decision-making process in such case. In this study, a budget impact model was aimed at estimating the effect of introducing Glucosamine usage in patients with knee osteoarthritis. The model was developed based on the disease-based framework and the indication-based analysis. The analysis was conducted based on the hospital perspective. Data inputs were obtained from historical utilization data, literatures, and physicians' opinions. Probabilistic analysis by using the Monte-Carlo simulation was used to determine the probable drug budget and total budget of knee osteoarthritis treatments after glucosamine has been listed in the hospital formulary. Analysis results showed that glucosamine has gradually penetrated the share of drug uses. Comparing to 2004, the impact on the hospital budget affected by glucosamine were gradually increased from 0.8, 0.6, 0.5 and 0.2 million baht in 2006-2009 respectively. An average of drug budget increased was 0.43 million baht per year which approximately equated to the healthcare expenses of 5 knee replacement patients. The growth rates of drug budget and total budget of knee osteoarthritis treatment in these years were lower than the regular growth rate seen in 2003-2004. Costs of glucosamine and costs of celecoxib were the most two sensitive variables in the forecast model. In brief, based on the analysis results, to include glucosamine into hospital formulary might be worthy of note if glucosamine can effectively delay progression in patients. However, in order to make the results less uncertain, key sensitive variables should be further investigated and re calculation of budget impact was also recommended.